Well, my new book is off to the printer. Over the next couple of days I’m hopeful I’ll have some reviews to pass on. One question that arises is why I chose the elder client as the topic for this book. Here’s the story behind that decision:

The Empowered Paralegal: Working with the Elder Client

Preface

My first “real job” was working as a janitor in a hospital in western Massachusetts. Being new to the staff I often found my self assigned the wing of the hospital that cared for elderly patients. This was a wing in which no one on the staff wanted to work. The patients were generally senile and generally dying. They were all, of course, “old” and no one was anxious to be around old, senile or dying people.
Many of these patients were tied to their beds. Many had little or no sense of where they were. Some would repeat phrases or individual words endlessly. Often the repeated word was, “Nurse.” Almost all had constant needs – the need to be cleaned, the need to roll over, the need to be acknowledged.

As I moved from room to room mopping and dusting, morning after morning, two things came to mind. First, these people, being elderly and approaching the ends of their lives even if they were not –at that moment – dying, had a good number of commonalities. Second, however, each of them was different. Each had their own particular instance of whatever disease or ailment brought them to the hospital even if many of the other patients had the same disease or ailment. More importantly, each had his or her own personality and, if not suffering from constant dementia, their own approach or perspective on their current state, their future, and their approaching death.

One of the advantages of being a janitor is that, unless there is a specific need, you are largely invisible. Being unnoticed, you can observe not only the patients but their families and the medical staff. Here to, I found commonalities. But among families, I saw remarkable differences not only in personalities and temperaments, but in their approach to the current status, the future and the approach to the end of life of their loved ones. The broadest, most superficial commonalities arose from the mere fact that those loved ones were elderly and in the hospital. Other commonalities appeared to arise from cultural, religious, educational, and economic factors.

Our area did not have a lot of diversity. However, there was enough to see that common elements of the perspective of second generation Italian-Americans from the northern-New England “Yankees” of my mother’s family and the French/German influence on my father’s family. The Protestant perspective was not much different from the Catholic, although the differences were perceptible. There were common factors in the approaches of the poor, distinguishable from those of the middle class, which were equally distinguishable from the rich (although the truly rich seldom found it necessary to die in the public hospital.) Perspectives changed with the level of education. Combining these factors with differences in attitudes that existed between generations within each family resulted is a multitude of individual emotional and intellectual reactions to illness, aging, disability, dementia and death.

Yet, it appeared to me that medical service providers had only one approach that they applied to all of the patients and, if they paid any heed to the families at all, to those who loved and, except for the duration of their hospitalization, provided care for them. Caught up in the science of medicine – the machines, the charts, the new techniques, perhaps combined with a need to depersonalize the patients in order to remain objective, the approach was often one of intellectual superiority, of knowing better than the patient or their families what the patient wanted or needed, of knowing better than the patient or their families when, how, and where it was better for the patient to grow old or die. Patients appeared to be just patients, not necessarily people in the sense of individual persons.

Thus the only perspective that mattered was that of the medical providers. It is not that they did not care, often deeply, for their patients. It appeared simply that they believed there was only one way to care for the patients, regardless of the individual perspective and personality of the patient – their way. I was in high-school at the time, convinced that I was going to become a doctor myself, so my focus was on the medical profession. It was not until a decade later as I began the practice of law that I realized the legal profession was often afflicted with the same narrowness.

In my last year of high school Elizabeth Kubler-Ross published On Death and Dying beginning the long process of changing the medical profession’s perception of the “right” way to care for the dying patients. Since then great progress has been made not only in the medical profession’s approach to death and dying, but in the approach to aging and the elderly with new research assisting in the understanding of the elderly in terms of medicine, sociology, law and many other aspects of society. It is my hope in this book to digest and present much of that knowledge for the paralegal – the person in the law office most involved in interacting with the client – so that the paralegal will be empowered to best meet the needs of the elderly client and to manage that client as part of the legal team.

I’ve returned to Maine for the holidays. During some of the quiet times I am working on my new book, The Empowered Paralegal Approach to Elder Law.” Those of you who have read “The Empowered Paralegal” know that the basic approach to dealing with clients is understanding not only their legal needs, wants and goals, but understanding the client him or herself in a way that allows the paralegal to remove barriers to communication and properly manage the client as a member of the legal team. This takes on a special meaning with elderly clients and often means applying the same principles to the client’s family. Clearly many elderly clients need special accommodations due to diminution in mobility, hearing and sight. However, it is also important for the paralegal to be aware of the basics of psychology of aging and the varying perceptions that clients and their families have of aging, dying and death, as well as the effects that those perspectives have on the client and their families as they work through legal issues.

I am very interested in hearing from practicing paralegals about their experiences with elderly clients and their families. Please contact me by comment here or email me at theempoweredparalegal@live.com with your comments, problems, concerns, accommodations or stories regarding elderly clients.